Plantar fasciitis is the most common cause of heel pain. The underside of the foot contains plantar fascia, which is a super tough, fibrous connective tissue from the heel to the toes. It provides support to the arches of the foot and crucial sensory information to the nervous system. Once previously thought to be due to inflammation (hence the “itis”), we now understand that true plantar fasciitis has NO inflammatory cells.[i]
Pain with first steps in the morning or after resting (sitting for prolonged periods of time) is quite common. Interestingly, there is often no pain during movement. Oftentimes people will have had a sudden increase in their activity levels prior to the pain.
Plantar fasciitis is commonly thought of as an overuse injury. Although this is true in many cases, this can sometimes lead people to believe that rest is their only option. This rest might lead people to do less over time, which will weaken the structures in and near the foot. This deconditioning may lead to injury or more pain over time.
It is better to view the current condition as being unprepared for your current tasks and hobbies. Addressing deficits in range of motion, strength, and balance will produce results over time. Combined with adjusting your activities, such as length of time, rest breaks, and the intensity, will ensure long-term results.
The plantar fascia is biologically like a tendon in its function. This means we can use the same modern principles of tendinopathy treatment to address the plantar fascia. Tendons love to be loaded up and work hard, and we know this is required for them to become more mobile, stronger, and increase their capacity.
Trigger points are areas in the body with decreased blood flow that, over time, cause pain in regions further from the body. If you have tried everything to massage your foot with no relief, you may have active trigger points in the muscles along the lower leg that are contributing to your pain. Trigger point dry needling is super helpful for plantar fasciitis because it can offer immediate pain relief while pinpointing muscles away from the site of pain that are contributing to the painful experience. These muscles may also need to be strengthened to prevent plantar fasciitis from returning.
Plantar fasciitis may take weeks to a few months to heal, so it is an incredibly frustrating condition to deal with. Understanding that there are deficits than can be improved usually serves as motivators and it is satisfying to see yourself progress in strength, balance, and pain levels as you work towards goals. If you are experiencing heel and foot pain, feel free to schedule your discovery visit today!
- Christian Bechara, PT, DPT, CMTPT
[i] Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93:234–7.
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